The feasibility of uterine-vaginal axis MRI-based as evaluation of surgical efficacy in women with pelvic organ prolapse

Haifeng Wang, Jihong Shen, Song Li, Zhenhua Gao, Kunbin Ke, Peng Gu, Haifeng Wang, Jihong Shen, Song Li, Zhenhua Gao, Kunbin Ke, Peng Gu

Abstract

Background: The aim of this study was to provide a potential surgical efficacy assessment in the treatment of pelvic organ prolapse (POP).

Methods: A retrospective cohort study was performed on magnetic resonance imaging (MRI) imaging data of 16 non-prolapsed (control group) and 30 preoperative and postoperative POP (case group) women from 2019 to 2021 at the First Affiliated Hospital of Kunming Medical University. MRI diagnoses and measures of the relevant anatomical points at rest were used to analyze the healthy control data and the data from POP women before and after surgery.

Results: The middle vaginal-PICS line angle (78.12°±15.03° vs. 69.35°±11.51°, 78.12°±15.03° vs. 61.56°±9.58°, P<0.05) and the middle-lower vaginal angle (179.30°±12.96° vs. 161.73°±10.42°, 179.30°±12.96° vs. 147.01°±12.20°, P<0.05) in the preoperative group were significantly larger than those in the control and postoperative groups. Y-axis coordinates of the endocervical orifice (-52.39±15.63 vs. -59.04±11.49 mm, -52.39±15.63 vs. -65.27±7.25 mm, P<0.05), posterior vaginal fornix (-34.25±13.30 vs. -46.69±11.09 mm, -34.25±13.30 vs. -49.93±8.02 mm, P<0.05), the junction of the middle and lower vagina (-0.48±8.65 vs. -11.34±7.33 mm, -0.48±8.65 vs. -10.11±9.77 mm, P<0.05), and anterior vaginal fornix (-23.14±13.71 vs. -34.68±9.07 mm, -23.14±13.71 vs. -38.64±6.48 mm, P<0.05), as well as the x-axes of the junction of the middle and lower parts of the vagina (26.79±6.71 vs. 19.56±5.24, 26.79±6.71 vs. 17.67±5.81, P<0.05), and vaginal introitus (23.39±7.12 vs. 18.55±4.22, 23.39±7.12 vs. 19.00±4.55, P<0.05) in the preoperative group were smaller than those of the control and postoperative groups. Differences between the control and postoperative groups were not statistically significant (P>0.05).

Conclusions: The current study established that the uterine-vaginal axis of POP women moved backward and downward in the coordinate system, as shown on MRI sagittal images. Further, it moved forward and upwards after surgical repair and more closely resembled that of the control group. The uterine-vaginal axis may provide an evaluation of surgical efficacy in women with POP.

Keywords: Magnetic resonance imaging (MRI); pelvic organ prolapse (POP); uterine axis; vaginal angle; vaginal axis.

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://atm.amegroups.com/article/view/10.21037/atm-22-1173/coif). The authors have no conflicts of interest to declare.

2022 Annals of Translational Medicine. All rights reserved.

Figures

Figure 1
Figure 1
Uterus and vagina analysis. (A) The central sagittal MRI of one subject in the control group; (B) the sagittal median MRI of one subject in the prolapsed group before surgery; (C) the median sagittal MRI of one subject in prolapsed group after surgery. X-axis: 34° clockwise rotation of the SCIPP line. Y-axis: perpendicular to the X-axis through the inferior point of the pubic symphysis. a: apex of the uterus; b: internal orifice of the cervix; c: external orifice of the cervix; d: posterior vaginal fornix; e: anterior vaginal fornix; f: the junction of the middle and lower vagina; g: vaginal introitus; j: sacral promontory; i: the inferior point of the pubic symphysis; h: the junction between the fifth sacral and first coccygeal bone. MRI, magnetic resonance imaging.
Figure 2
Figure 2
The position and angles of the uterine vaginal axis. d1: upper vaginal-PICS line angle; d2: middle vaginal-PICS line angle; d3: lower vaginal-PICS line angle; d4: middle-lower vaginal angle; d5: upper-middle vaginal angle; d6: cervix-upper vaginal angle; d7: uterine body-cervix angle. SCIPP line: obtained by connecting a line drawn from the inferior point of the pubic symphysis to the junction between the fifth sacral and first coccygeal bone. PICS line: rotating SCIPP line by 34 degrees in the clockwise direction. X-axis: 34° clockwise rotation of the SCIPP line. Y-axis: perpendicular to the X-axis through the inferior point of the pubic symphysis.
Figure 3
Figure 3
Analysis of the average shape and position of the uterine-vaginal axis on the median sagittal plane in the created local coordinate system. All figures’ units are mm. (A) The results of 16 control group women. The blue point represents the position and coordinate value of the average coordinate of the uterine-vaginal axis, and the blue line represents the average shape. (B) The preoperative results of 30 subjects with POP. The red point represents the position and coordinate value of the average coordinate of the uterine-vaginal axis, and the red line represents the average shape. (C) The postoperative results of 30 subjects in the POP group. The green point represents the position and coordinate value of the average coordinate of the uterine-vaginal axis, and the green line shows the average shape. (D) The average coordinate position and average shape of the uterine-vaginal axis in the control group and case group (before and after operation). The blue is the average shape of the control group, the red is the average shape in the prolapse group before the operation, and the green is the average shape in the prolapse group before operation. X-axis: 34° clockwise rotation of the SCIPP line. Y-axis: perpendicular to the X-axis through the inferior point of the pubic symphysis. a: apex of the uterus; b: internal orifice of the cervix; c: external orifice of the cervix; d: posterior vaginal fornix; e: anterior vaginal fornix, f: the junction of the middle and lower vagina; g: vaginal introitus. POP, pelvic organ prolapse.

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